Female Sexual Disorders
SEXUAL DYSFUNCTIONS IN FEMALES:
- 1) SEXUAL DESIRE DISORDERS :
- Hypoactive sexual desire disorder
- Sexual aversion/ inhibition Syndrome
- Hyperactive sexual desire disorder (?)
- 2) SEXUAL AROUSAL DISORDER :
- Female arousal disorder
- 3) SEXUAL ORGASMIC DISORDER
- Inhibited female orgasm
- 4) PAINFUL SEXUAL SYNDROME
- Female Dyspareunia
- Vaginismus
LACK OF SEXUAL DESIRE
Persistently or recurrently deficient (or absent) sexual fantasies and desire for the sexual activity. It causes marked distress or interpersonal difficulty amongst the partners.
Sexual desire is expressed in sexual dreams, fantasies, attraction to erotic material, wish for sexual activity etc.
Women having low/absent sexual desire have low/absent interest in initiating any sexual behaviors and do not respond to partner’s sexual urges.
Any individual’s sexual urge may not remain same throughout the life. It may have natural ups and down. It also changes in relation to one’s age, nature of upbringing, current relationship and other situational factors.
Causes:
- Organic : any condition which causes disturbances in hormones esp. low level of Testosterone hormone, Low level of thyroid hormone and high level of Prolactin in blood may lead to low sex desire. Pituitary Diseases and Primary Testicular Diseases are mainly responsible.
Systemic diseases that causes testicular disorders… like Chronic Renal Failure, Cirrhosis, Cushing’s Syndrome, Estrogen producing Tumors, Hypothyroidism, Diabetes Mellitus, Stroke, Parkinson’s Disease and certain Medicines can also cause this situation. - Psychogenic : Anger, fear & distraction etc can act as ‘turn off’ mechanism. Some factors cause negative thoughts. Guilt about sex, anticipation of lack of pleasure, Emotional distress, Depression, Interpersonal conflicts between the partners, hostility, lack of trust, rejection etc. can also reduces sex drive.
Laboratory Investigations :
General investigations like Blood Sugar, Lipids, Liver function tests, Kidney function tests etc. should be performed to identify underlying causes.
Hormonal assay like Testosterone, FSH, LH, Prolactin may be necessary.
Treatment :
Counselling and Psychosexual Therapy is the main backbone of the treatment.
Couple marital Counselling and sexuality education may be necessary for the problems when both the partners have relationship problems. Behavioural therapy helps to reduce performance anxiety. The main aim of the therapy is to remove guilt and fears blocking the natural sexual response
Medicines have a very little role in sexual desire disorders.
Sex Tonics (Aphrodisiacs) : It is a common belief that certain substances like Ginseng, Rhino horn powder, Tiger’s bones, Food substances like Onion, Garlic can enhance the sexual desire. But, there is no drug or food substance that increases the sexual power.
SEXUAL AROUSAL DISORDER (FRIGIDITY)
A persistent or recurrent inability to attain or to maintain sexual arousal (lubrication) until completion of sexual activity.
It was also known as “frigidity” earlier. She is devoid of sexual feelings. She derives no sexual pleasure from sexual stimulations. This disorder is usually associated with low desire disorder and she has difficulty in experiencing climax too.
The person having this disorder shows no lubrication in response to sexual stimulation. She is devoid of sexual feelings. She feels no pleasure from sexual stimulations. It may result in painful intercourse, sexual avoidance and disturbance of marital and sexual relationship.
Lab Investigations : as mentioned in desire disorder
Treatment : largely consists of Counselling and Psychotherapy.
Removal of guilt, nervousness, fear, depression etc helps tremendously. Modifying dislike for the partner or his few turn off habits can be beneficial.
Women’s sexual desire and pleasure is very much partner oriented. Hence, involvement of the partner and support from him will always give improvements. Couple is jointly counseled to dissolve major issues that bothers them. Thru mutual support and co-operation, this can be cured.
FEMALE ORGASMIC DISORDER (INABILITY TO REACH CLIMAX)
A persistent or recurrent delay in or absence of orgasm following a normal sexual excitement. Women show many variations in type or intensity of stimulations which cause climax. This disorder may affect the self esteem and relationship. Ability to feel climax during sex increases with age and regular sexual experiences as they experience wider variety of sexual stimulations and acquire more knowledge about their own body.
Causes :
I. Psychogenic : largely the orgasmic disorders are psychogenic in origin. Negative signals related to the sex can prevent the free erotic feelings.
- Developmental : rigid religious orthodoxy, childhood traumatic experience etc. it can cause anxiety and guilt. Strict upbringing and orthodoxy puts derogatory image about sexuality in their mind. Later in adult age also they consider sex as a taboo and their erotic experiences get inhibited.
- Affective : Guilt, Poor Self-esteem, Performance anxiety, Depression etc.
- Interpersonal : Hostility, Divergent sexual needs, Poor communication. If the couple has general poor communication between each other or if there is strong hostility between them then the sexual relationship also may lack intimacy and woman may not experience climax. Often both man and woman may have different erotic requirements. May may like breast stroking which his partner may not like or man likes prolonged lip-lock kissing but woman may get turned off.
- Cognitional : Ignorance about sex, Acceptance of cultural beliefs etc. Surprisingly, there are large number of women who are not aware about the erotic zones of their body like ear pinnas, breasts, clitoris etc. Since, the erotic area are not strokes enough, they fail to reach climax during sex.
- Miscellaneous : Boredom / Monotony, Partner’s poor performance etc. Often men does the same pattern of foreplay in same position for many years. A woman may get bored by the same act. Often the man is not bothered about the sexual needs of the woman. After sex, he may sleep immediately without bothering for woman’s sexual pleasure. Some men may have sexual disorders like erectile dysfunction and premature ejaculation which results into poor performance during sex and wife remains without climax.
II. Organic : Neurological factors (spinal cord diseases, peripheral nerve diseases), some hormonal disorders and certain anti-depressant drugs can impair ability to experience sexual climax in women.
PAINFUL SEX (DYSPAREUNIA)
Recurrent and persistent genital pain associated with sexual intercourse in female.
Causes:
Fear, anxiety, anger etc. distracts the attention causing less lubrication in sexual arousal phase. Anger, fear & distraction etc can act as ‘turn off’ mechanism. Some factors cause negative thoughts.
Guilt about sex, anticipation of lack of pleasure, Emotional distress, Depression, Interpersonal conflicts between the partners, hostility, lack of trust, rejection etc. can also turn her off. If sex is attempted without her desire, it may be painful to her.
II. Organic :
Infections, Mucosal atrophy ( after menopause causes dryness in vaginal walls), Rigid Hymen, Pelvic Inflammatory Diseases, Endometriosis etc. can cause actual inflammation in the vagina leading to painful sex.
VAGINISMUS
Recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina that interferes with sexual intercourse.
The disturbance causes marked distress or interpersonal difficulty.
Often presents as Non-consummation of marriage or Primary Infertility.
Vaginismus can be mild, moderate or severe. In some women even anticipation of vaginal insertion may result in tightening of muscles (spasm) and prevention of penetration.
These women can experience sexual excitement and even climax also by manual stimulation but thought or attempt to penetrate can cause severe spasm of vaginal muscles preventing insertion.
Husband may develop erectile dysfunction following persistent unsuccessful penetration.
Causes : Vaginismus is a reflex spasm taking place as a result of the anticipated pain. Variety of psychological factors are responsible for this problem. Woman may consider sex as a dirty, sinful and shameful act because of religious orthodoxy. A woman may have phobia due to childhood sexual abuse. Some times she may want to avoid pregnancy and may not be willing for sex.
Organic causes are..rigid hymen, infections, birth deformities etc.
Examination : during examination, it is very easily obvious. The thighs muscles may also be stiff and there is guarding of the genital organs. In severe cases, she may not allow internal examination
Treatment : like any sexual disorder, this is also considered as a couple problem. Participation of both the partners in treatment will always give assured, quick and more satisfying results.
Treatment mainly consists of counselling and sex therapy. The main aim of the treatment is to remove the fear of penetration from the woman’s mind. She should be explained the sexual organs system. She needs to be reassured that act of penetration can cause only mild pain.
Sometimes to remove the fear and give confidence to the woman, vaginal dilatation is done with the help of the local anesthetic lubricating jelly.
Considerable patience is required from all the persons involved in the treatment. Patient, her husband and therapist…all should have good patience to remove this fear.
Humour in sex
